I have to decide on the radiation thing
Hello sister BC warriors!
Fifteen years ago I had invasive stage one, with radiation in the right breast. Decided against chemo but was encouraged. All was well (except for stage 1 grade C ovarian cancer two years ago) until my mammo in Nov. revealing DCIS in the lower right side of my left breast. Anyway, they want me to have radiation for three weeks. Not so bad, but I am very concerned that where this site is, is located right by my heart. I can see my heart beating in that very place. I saw my oncologist today to check up on CA-125 and new DCIS. My fav. doc quit and now I have this new one. I don't really like him and he would not discuss the radiation at all. So on Monday I see the rad doc. I don't know what to do. My gut says don't do the rads, but the stats the onc gave me today takes me down quite a bit from 11% to 4%. I think 11% is pretty good on it's own. So....just looking for some comments I guess. I know I'm the boss and I have been trying to do my homework. This is harder than when I had invasive, since now I tend to think I don't need it, it is available, it statistically will be better, but it could damage my heart or lungs, which I suspect the docs won't want to talk about. As I understand it, it won't help me survive, but will help prevent new cancer. I have had four biopsies and ovarian cancer so I think I am becoming desensitized to the idea of having cancer. Anyone?
Comments
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Have they run the DCIS version of OncotypeDX (yes, there is one) on your tumor tissue? Some oncs use it to rule out the need for rads in DCIS patients. You can also ask about having radiation in a prone position to minimize heart-lung damage--and from the sound of “3 weeks” I would guess it’s partial-breast, rather than whole-breast radiation. I don’t know your age, but to me a 7% difference in 15-yr recurrence is pretty significant. (Remember, our odds of getting breast cancer in our lifetimes were only one in eight, yet here we all are). If the difference were only 1 or 2%, I would say the risks outweigh the benefits; but if you’re heart-healthy with good lungs (and younger than 60), I think the opposite would be true. If you are over 70, they may advise skipping radiation.
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I have to agree 100% with ChiSandy, she makes some very valid points.
I would ask your RO about having radiation in the prone position. That does make a big difference and helps to keep the heart clear of the radiation.Since you had IDC, ovarian cancer, and now DCIS, I would do everything in my power to prevent any more cancer from forming. But, that's just me.
This is such a hard "journey" (for lack of a better word), to navigate. So much of this a crap shoot! We do what we feel is best with the info that we have and move forward. It's tough to make decisions with such limited info.
The bottom line....get as much info as you possibly can, get a second opinion if you feel it will help, and then make your decision. I'm sure that helped, right? LOL! Sorry....like I said, knowing what to do is tough! -
Thank you for your thoughtful insights. I'm trying to get to the bottom of why I don't want to have rads this time. I think it is about how much accumulative radiation I have already had. All those mammos, all the pictures for the two needle locs. All the radiation from the last breast cancer, C-scans for ovarian cancer (2 so far.) Is there radiation as well during simulation? I seem to be prone to getting cancer now. I am thin, 110 lbs. active, no ovaries, neg. for genetics, I don't get it. I get hot flashes every night (low on estrogen?), almost a vegetarian, take my vitamins/supplements.I eat organic and don't use chemicals. I even make my own laundry soap! I would say 'why me' but I know the answer. I am going to look through as much as I can on this forum so I can try to make a decent decision for myself on Monday. To answer the question about my age etc. I am 65, I had chemo of the severe kind with ovarian cancer so I may or may not have some heart damage. I had lots of pain so they did a test during chemo to check my heart, which showed it was OK. Such is life, it's a gamble and a crap shoot. I have a feeling I will be talked into the rads. Will ask for the prone position. And in all fairness, I have not met this rad doc and so I hope he will look out for me!
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When I met my RO, I specifically asked him about heart, lung damage. He said they got a new machine, could stop the beams from going there. Asked about scatter. He said none to worry about. He was an MD, and a PhD.
3 years later, I'm showing some heart damage from the red devil, lungs ok.
Ask LOTS of questions!!!
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Oh, sorry to hear that. This is what I am concerned about. That I have only myself to look to for the final answer. I know they have good intentions. But radiation is their game, after all. I hope you are OK. and thanks for sharing that. Any info I get will help me make my decision.
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Could your heart problem have been caused by your chemo?
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I tend to think I would rather face another early cancer than heart or lung damage from radiation. I can live w/o my breast. I have not had wild and crazy types of breast cancer. Mine is not so scary I think.
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Bolus (a pad) is/can be used to limit the penetration depth of the radiation. One of the areas done on me a bolus was used then was removed before the machine moved to the other areas done.
I was 63 when DXd - 69 now. I had not heart/lung issues before Chemo and/or rads - still have none. Still NED (No Evidence of Disease) with IBC.
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Thanks. I will ask about that. I'm happy that you are cancer free now
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I had radiation on my left side, and the facility I went to used the active breathing technique to help protect my heart. From the website:
When Active Breathing Coordinator is used during radiation therapy, the patient takes a deep breath before the beam of radiation is delivered. This deep breath increases the distance between the area receiving radiation (the breast tissue or chest wall on the patient's left side) and the heart. Increasing this distance means there is less risk the heart will receive any incidental radiation during treatment and, therefore, there is less risk of the patient developing radiation-induced heart disease.
More information is available at the following link:
http://www.swedish.org/services/cancer-institute/o...
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Thank you. On my list for Mondays consult,
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Hi. I just happened on this place by accident, so I shall put in my two cents worth, uninvited.
When I had my surgery, BMX, and lab work done, my number was considered low and so chemo was not advised. However, they did recommend AIs and rads. Rads doc did not have a significant difference in recurrence score (I think maybe 7 points), but said that he strongly recommended that I take it. My gut feeling was not to have radiation, that it was a danger. I followed my gut feeling and told him "No, Thank you." Glad I did. Life is full of so many other concerns - - I do not need to add rads damage to them.
My gut feeling was also to not take the AI. but I took it anyway. I should have listened. 5 weeks into it I had all kinds of things go wrong. It has taken several years to repair the damage. Thankfully, I am better now.
So, my advice is "Follow your gut."
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Onco, I have followed my gut a number of times and been what I now consider to have been very wrong. So in my case, following my gut really leaves me nowhere in the decision making process, unfortunately. For others I know, it has helped them make a wise choice.
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gentian, sorry you had poor outcome. Different people, different "guts", I guess.
I guess it almost comes down to a flip of the quarter, isn't it?
There are no guarantees.
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Onco, today that is what I have been thinking...it's a crap shoot, a gamble, no matter what one decides to do. Either way, it is risky. And as they say, so is getting in your car everyday. So I ended up with not so many questions for tomorrow as I had anticipated. Many of my questions have been answered by reading this forum today, and by the responses you have all given me. Thanks! The last thing is to talk to the RO and cancel my simulation. I need another week to soak up what I have learned before I decide. My own gut says not to. I have found through experience to follow it. I just hope I like the RO and can talk and be listened to, unlike my new MO.
Thanks for all your replies and well wishes. I'm sending good thoughts out to all of you too. Stay strong and do your best... it is good enough!
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Has anyone had internal radiation? I have that as an option although I must travel to another county and stay with my son and DIL for 5 days. It's given twice a day for 5 days then I'm done.
I didn't learn about radiation during surgery, Intraoperative radiation therapy (IORT), until my surgery was being scheduled and it is not yet offered in my county. If I had known about it prior to surgery I would have traveled to the other county had had surgery and radiation completed at the same time. So now I"m left with a choice of the 6 week radiation, or 3+ week radiation, both in my county, or moving in with my kids and doing it all in 5 days.
I would love to hear experiences of others who have the various types of radiation.
Thanks all!
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Onco - I didn't mean to sound so pessimistic, I have made good choices with my gut too. The one that makes me feel I was so wrong was to allow myselt to take a progestin while on natural estrogen during menopause. I was on it for eleven years.......way too long and I finally changed gynocologists. Once I quit the progestin I then went to a new gyn and started progesterone and although some feel it as equally dangerous as a progestin, I do not. In hind sight I now know (with all the studies) that progestin can easily be a forerunner to breast cancer. Clearly the progestin was a poor choice. Sorry, I didn't mean to hijack this thread but just wanted to explain why my gut didn't work in a major decision.
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Neen, Shirley from Texas (aka waterstreet) had the brachytherapy (5 days of twice-daily insertion of radioactive material into implanted catheters, which were then removed). She had some trouble with seromas & infection. Some women breeze through it. It is a PITA, because each day 6 hrs. must pass between treatments--which means either driving up & back twice or hanging around the hospital all day. (Hard to go shopping or out to lunch because the catheters can be quite uncomfortable). Because of the types of complications Shirley experienced, many ROs have stopped offering it. I had instead 16 daily extra-strength treatments to only the tumor cavity and a small surrounding area. Minimized the side effects: no fatigue, irritation or broken skin; it did enlarge my cavity seroma, painlessly redden and eventually tan the skin, and cause some mild fine flaking (like dandruff). No biggie. Wore my underwires throughout.
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I wonder, if the cancer comes back in the original site, since the breast tissue is gone, what is it like? For me having DCIS, the ducts are removed with the cells in question. The cells are no longer in the ducts. I don't get it. Don't like to sound ignorant, but guess it will be on my list for today.
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mine came back after mastectomy. All it takes is a cell left behind to grow into a new tumor, even though there are no ducts
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Neen, I had brachytherapy via a SAVI device with success. It's actually about a 10 day process with pre-testing, insertion of device then 5 day/twice a day treatment. If you click on the "search" icon in the upper left column, and search brachytherapy, you will see several threads have discussed the pros and cons. Best wishes and let us know how you're doing.
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Hi Neen56!
I had brachytherapy with a Mammosite catheter. Between the spacer catheter placed during my surgery, the simulation, the replacement of the spacer with the actual Mammosite catheter, a weekend and a holiday, I believe I had the end of the catheter sticking our for something around 14 days before it was removed for good.
And I didn't have drains, so I can't really compare the catheter to JP drains. At any rate, my experience was a good one. My surgeon ordered prophylactic antibiotics during the entire period. I had to redress the catheter/wound myself on weekends/holidays. Otherwise, the nurses redressed it for me when I was seen.
Only problem I recall was a mechanical sensitivity to tape developing over the course of treatment. Placing/removing tape twice a day during treatment days was a bit hard on my skin. But my radiology nurses changed the dressing style to a "tapeless" dressing, using the breast binder that my surgeon had me wearing.
All in all, I was pleased to be done with the radiation with only five treatment days. And to only be radiating the tumor cavity. Since I was working at the time, I simply went in before and after work. Really not a scheduling problem at all.
HTH,
LisaAlissa
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Hello Sisters,
I did all my homework to meet with the RO this afternoon. As it turned out he was totally on the same page as me! He did not recommend any radiation, contrary to what my surgeon and MO said. Since my appointment for consult was an hour and we both agreed immediately that radiation would not be in the plan, and my simulation was scheduled the next hour, we spent the whole two hours talking. He showed me all my reports and scans from as far back as my ovarian cancer and written reports from my BC in 2001. He considered my whole situation and what I have been going through for the last two years with ovarian cancer, in his decision. It was so helpful to learn about how much radiation I would have gotten, how much is delivered by CT scan, chest x-ray, etc. He admitted that there was scatter to the body. He felt he could keep my heart and lungs safe if I would have had it, but had no guarantee. I got all my questions answered. If I get a recurrance I can still have another lumpectomy on the left side. But he would recommend mastectomy since it is likely to keep happening if that were the case. We covered all the bases and found out we both love pit bulls (I may be asked to do a painting
He was the most heartfelt dr. I think I have ever talked with.
I told him I didn't connect with my new MO and he suggested the same one I was thinking of asking for. So on my way out I was able to get my next appointment with that one, in April. According to the RO this new MO is the best and most sought after doc in our area.My CA-125 has risen from 6 to 12 in the last year. So he thinks we should keep a close watch on that. Otherwise.... Great day for me!
Thanks for all the help, ladies. You are all the best.
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ChiSandy, your response was very helpful. I have decided to do 16 radiation treatments. I am so relieved to hear your experience with it. Did you exercise during radiation? I worry about fatigue and glad to hear that wasn't a problem for you.
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